Form Ucs-840 - Request For Judicial Intervention
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1
2REQUEST FOR JUDICIAL INTERVENTION
For Court Clerk Use Only:
IAS Entry Date
UCS-840
(7/2012)
Supreme
________________________COURT,
COUNTY OF___________________________
Judge Assigned
Index No: _____________________
Date Index Issued:___________________
RJI Date
Enter the complete case caption. Do not use et al or et ano. If more space is required,
CAPTION:
attach a caption rider sheet.
Plaintiff(s)/Petitioner(s)
-against-
Defendant(s)/Respondent(s)
NATURE OF ACTION OR PROCEEDING:
Check ONE box only and specify where indicated.
MATRIMONIAL
COMMERCIAL
G
G
Contested
Business Entity (including corporations, partnerships, LLCs, etc.)
G
Contract
NOTE: For all Matrimonial actions where the parties have children under
G
the age of 18, complete and attach the MATRIMONIAL RJI Addendum.
Insurance (where insurer is a party, except arbitration)
G
For Uncontested Matrimonial actions, use RJI form UD-13.
UCC (including sales, negotiable instruments)
G
TORTS
Other Commercial:_________________________________________________
G
(specify)
Asbestos
G
Breast Implant
NOTE: For Commercial Division assignment requests [22 NYCRR '
G
202.70(d)], complete and attach the COMMERCIAL DIV RJI Addendum.
Environmental: ________________________________________________
(specify)
REAL PROPERTY
:
How many properties does the application include? _________
G
G
Medical, Dental, or Podiatric Malpractice
Condemnation
G
G
G
G
Motor Vehicle
Mortgage Foreclosure
:
Residential
Commercial
(specify)
G
Property Address: ____________________________________________________
Products Liability:_______________________________________________
(specify)
Street Address
City
State
Zip
G
Other Negligence:_______________________________________________
NOTE: For Mortgage Foreclosure actions involving a one- to four-family,
(specify)
owner-occupied, residential property, or an owner-occupied
G
condominium, complete and attach the FORECLOSURE RJI Addendum.
Other Professional Malpractice:____________________________________
G
(specify)
Tax Certiorari - Section: __________ Block: __________ Lot: __________
G
G
Other Tort:_____________________________________________________
Tax Foreclosure
G
(specify)
Other Real Property:________________________________________________
(specify)
OTHER MATTERS
G
SPECIAL PROCEEDINGS
Certificate of Incorporation/Dissolution
[see NOTE under Commercial]
G
G
Emergency Medical Treatment
CPLR Article 75 (Arbitration)
[see NOTE under Commercial]
G
G
Habeas Corpus
CPLR Article 78 (Body or Officer)
G
G
Local Court Appeal
Election Law
G
G
Mechanic's Lien
MHL Article 9.60 (Kendra's Law)
G
G
Name Change
MHL Article 10 (
)
Sex Offender Confinement-Initial
G
G
Pistol Permit Revocation Hearing
MHL Article 10 (
)
Sex Offender Confinement-Review
G
G
Sale or Finance of Religious/Not-for-Profit Property
MHL Article 81 (Guardianship)
G
G
Other:________________________________________________________
Other Mental Hygiene:______________________________________________
(specify)
(specify)
G
Other Special Proceeding:___________________________________________
(specify)
(specify)
STATUS OF ACTION OR PROCEEDING:
Answer YES or NO for EVERY question AND enter additional information where indicated.
YES
NO
G
G
Has a summons and complaint or summons w/notice been filed?
If yes, date filed: _____________________________
G
G
Has a summons and complaint or summons w/notice been served?
If yes, date served: _____________________________
G
G
Is this action/proceeding being filed post-judgment?
If yes, judgment date: _____________________________
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Parent category: Legal